Death and Desirability: Retrospective Reporting of Unintended Pregnancy After a Child’s Death

Abstract

Social scientists have long debated how to best measure pregnancy intentions. The standard measure relies on mothers’ retrospective reports of their intentions at the time of conception. Because women have already given birth at the time of this report, the resulting children’s health—including their vital status—may influence their mothers’ responses. We hypothesize that women are less likely to report that deceased children were from unintended pregnancies, which may explain why some cross-sectional studies have shown that children from unintended pregnancies have higher survival, despite the fact that longitudinal studies have shown the opposite is true. Using Demographic and Health Survey data from 31 sub-Saharan African countries, we confirm that mothers are less likely to report that deceased children resulted from unintended pregnancies compared with surviving children. However, the opposite is true for unhealthy children: mothers more commonly report that unhealthy children were from unintended pregnancies compared with healthier children. The results suggest that mothers (1) revise their recall of intentions after the traumatic experience of child death and/or (2) alter their reports in the face-to-face interview. The study challenges the reliability of retrospective reports of pregnancy intentions in high-mortality settings and thus also our current knowledge of the levels and consequences of unintended pregnancies in these contexts.

Keywords

Notes

Acknowledgments

The authors gratefully acknowledge use of the services and facilities of the Population Studies Center at the University of Michigan, funded by NICHD Center Grant R24 HD041028 and the support of an NICHD training grant to the Population Studies Center at the University of Michigan (T32 HD007339) during the preparation of this manuscript. The manuscript benefited greatly from feedback Sara Yeatman and Jenny Trinitapoli graciously provided. We also thank three anonymous reviewers and the Editor for helping us further improve the manuscript. The paper also benefited from valuable feedback from participants in Session 149 (Fertility: Childbearing Decisions, Regrets, and Reassessments) at the 2015 American Sociological Association, UCLA California Center for Population Research Seminar series, and the UC-Irvine Center for Demographic and Social Analysis speaker series.

Appendix

Table 5

List of countries, year of DHS survey, and corresponding sample size of children younger than five years old

Total No. of Children Younger Than 5 Years

Subsample of Youngest Child per Mother

Final Sample for Child Mortality Analysis

Final Subsample for Child Health Analysis (only living children)

Benin (2011)

13,386

8,938

8,880

5,104

Burkina Faso (2010)

15,091

10,190

10,144

4,578

Burundi (2010)

7,736

4,815

4,797

2,192

Cameroon (2011)

11,799

7,598

7,519

3,373

Chad (2004)

5,666

3,472

3,441

2,834

Congo (Brazzaville) (2011)

9,296

6,339

6,310

3,100

Democratic Republic of the Congo (2007)

9,118

5,495

5,416

2,010

Ethiopia (2003)

11,852

7,808

7,751

6,584

Gabon (2012)

6,108

4,114

4,067

2,306

Ghana (2008)

3,026

2,151

2,132

1,740

Guinea (2012)

7,074

4,935

4,894

2,234

Kenya (2008)

6,138

4,090

4,067

3,454

Ivory Coast (2011)

7,875

5,406

5,349

2,277

Lesotho (2009)

4,037

3,154

3,130

1,274

Liberia (2006)

5,869

4,020

3,965

3,118

Madagascar (2008)

12,610

8,583

8,494

3,386

Malawi (2010)

20,015

13,534

13,451

3,103

Mali (2006)

14,266

8,870

8,808

7,106

Mozambique (2011)

11,133

7,534

7,500

6,351

Namibia (2006)

5,211

4,017

3,978

2,909

Niger (2012)

12,634

7,565

7,514

2,890

Nigeria (2008)

28,803

17,811

17,599

12,030

Rwanda (2010)

9,007

6,229

6,188

2,905

Sao Tome Principe (2008)

1,953

1,446

1,429

1,076

Senegal (2010)

12,390

8,080

8,039

2,399

Sierra Leone (2008)

5,700

3,988

3,918

1,463

Swaziland (2006)

2,840

2,136

2,120

1,560

Tanzania (2009)

8,102

5,353

5,318

4,667

Uganda (2011)

8,002

4,908

4,871

1,322

Zambia (2007)

6,470

4,154

4,139

3,373

Zimbabwe (2010)

5,581

4,368

4,343

3,475

Total

288,788

191,101

189,571

106,193

Source: Demographic and Health Survey.

Table 6

Descriptive statistics for children from 31 sub-Saharan African countries, by analytic sample and mother’s retrospective report of whether the child resulted from an unintended vs. intended pregnancy

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